We know that many dentists are loyal customers of Happythreads, and we thought it might be interesting to see how French dentists are dealing with the issues raised by COVID-19.

We have translated and summarised advice from the Association Dentaire Francaise for Dental professionals during the COVID-19 crisis. We’ve also shared some information about how French dentists are raising awareness about issues sourcing PPE!

How French Dentists are protesting the lack of PPE

We all know by now that the issues with obtaining suitable PPE are global, urgent, and show no signs of abating. The dental professionals of France, however, are raising awareness of this issue in their own particular way.

Numerous dental professionals have highlighted the lack of suitable PPE by taking to social media wearing *only* the PPE they have. In many cases, this is nothing at all, or a strategically placed mask or two!

Holding signs saying “Naked Dentists”, they are using nudity to demonstrate how exposed they feel without the necessary safety equipment!

When is an in-person consultation/intervention necessary?

Dental procedures are highly likely to generate aerosolised saliva, which is one of the main vectors of transmission for SARS-CoV-2, the virus which causes COVID-19. Therefore dentists need to do everything they can to limit exposure for themselves and their patients.

If you are a member of a high-risk group you should not perform in-person consultation. If you become sick you should stop working and arrange a test.

An in-person consultation is for dental emergencies only - this means strict management of acute infections, severe pain, severe bleeding, and trauma of the orofacial sphere.

• The resealing of crowns, bridges, permanent or temporary and whatever the clinical situation is not an emergency
• A painless fractured tooth is not an emergency
• A removable device fracture is not an emergency
• A painless cavity or with moderate pain is not an emergency
• Gingivitis is not an emergency.

Step 1: Triage

Initial consultation with patients should be by telephone to establish the level of need. If prescriptions are required these should be emailed/faxed. Appointments should only be made for patients with a genuine dental emergency.

Step 2: Scheduling Appointments

The scheduling of the appointment must take into account whether the patient is vulnerable or not and whether the patient is symptomatic or not:

• As far as possible, physically isolate symptomatic patients from others: dedicated waiting room, waiting outside the office, dedicated time slots
• Schedule vulnerable patients’ (aged over 70 or with underlying health conditions) who are not symptomatic in the earlier portion of the shift to avoid contact with symptomatic patients.
• Schedule symptomatic patients at the end of the shift.
• When planning appointments, you should include time for thorough ventilation and disinfection of the office after each appointment (whether the patient is symptomatic or not)

Step 3: Receiving Patients at the Practice

• Assume that every patient is potentially infected and take precautions accordingly.
• To reduce patient contact, the presence of a dental nurse is not recommended.
• Allow only one patient at a time (with one accompanying adult if the patient is a child)
• Upon arrival, the patient should wear a mask (especially important if they have a cough) and wash their hands with soap and water or use 60% alcohol-based hand sanitiser.
• In the waiting room: Remove magazines, magazines, and toys; Limit the number of chairs and leave a space of more than one metre between them
• Wipe health insurance cards and bank cards with a disinfectant solution or sanitise hands after touching them. Sanitise hands after handling cash.

Step 4: During Treatment

• Wear suitable PPE: protective glasses or visor, gloves, cap, long-sleeved gown, and an FFP2 mask
• Ask each patient to perform a mouthwash prior to any intervention.
• Use a dental dam when using dynamic instruments.
• Keep all work surfaces clear and cover with a protective shield or screen
• Protect any IT equipment with a protective shield or screen
• Thoroughly ventilate the room at the end of each treatment
• Disinfect carefully after each treatment including the door handles

Step 5: Changing PPE

• Change your FFP2 mask every 4 hours (unless it has been soiled or you have touched it)
• Between each patient appointment:
• Change gloves (sanitise hands between glove changes)
• Clean your protective glasses with disinfectant wipes
• Where possible change your gown and cap
• Ventilate the treatment room for 10 minutes
• While ventilating, thoroughly disinfect surfaces (chair, unit, worktop, door handles etc.).